Background

AL amyloidosis results in kidney failure in about 15-30% of patients and is considered a relative contraindication for kidney transplantation. There is limited data on the outcomes in patients who have undergone kidney transplantation.

Methods

Chart review of 12 patients who underwent kidney transplantation between 2000 and 2017, after receiving autologous stem cell transplantation (ASCT) for AL amyloidosis. Primary outcomes of interest were kidney allograft survival and hematologic remission post kidney transplantation.

Results

AL amyloidosis of the kidney was biopsy proven in 11 of 12 patients. Lambda light chain was predominant in 10 of 12 patients.

Median glomerular filtration rate (GFR) and proteinuria at time of diagnosis were 29.7 ml/min/m[sup2] and 12 g/day, respectively. Median duration of AL amyloidosis before the onset of end stage kidney disease (ESRD) was 11.7 months. Melphalan conditioned ASCT was the first line therapy in 9 of 12 patients. The remaining received bortezomib and dexamethasone, and due to suboptimal response to chemotherapy, underwent ASCT.

Median time from diagnosis and ESRD to kidney transplantation was 41.2 and 21.3 months, respectively. At the time of kidney transplantation, hematologic complete remission was seen in 8 patients, partial remission in 2, and progressive disease in 2. Eleven patients underwent living donor and one had a deceased donor kidney transplant. Induction regimen was basiliximab (N=5) or thymoglobulin (N=6). Maintenance immunosuppression was calcineurin inhibitor-based with (N=6) or without (N=6) corticosteroids.

The median patient survival from time of amyloidosis diagnosis was 98 months, and the median kidney allograft survival from time of kidney transplantation was 41 months. At the last follow up, median creatinine was 1.65 mg/dl. Four patients had hematologic progression after kidney transplant. All 4 successfully received salvage therapy including 1 patient who had a second ASCT and kidney transplant 10 years after initial therapy.

Conclusion

Our study shows encouraging results supporting kidney transplantation in patients with AL amyloidosis. Prospective studies are needed to better define eligibility criteria for kidney transplantation in patients who achieve a hematologic response to treatment for AL amyloidosis.

CITATION INFORMATION: Gutgarts V., Jaffer Sathick I., Rosenbaum C., Muthukumar T., Hassoun H., Flombaum C., Landau H. Outcomes after Kidney Transplantation in Patients with AL Amyloid Following Autologous Stem Cell Transplantation Am J Transplant. 2017;17 (suppl 3).

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